Written by James Le Lievre

 I have had a major turn around in my life.  I have been witness to the social adversity of a person who is close to me, who consequently experienced a break down, a diagnosis, and decades of medication.  I also experienced my own brief emotional trouble, resulting from adverse conditions, but fortunately, a very speedy recovery in the hands of a very skilled therapist.  It was during my own recovery that I began to study and realized the relationships between a person’s total social environment, the skills they possess to deal with this environment, and this persons mental health.  I have since observed this relationship over and over.  My study also revealed the possibility for change, which has encouraged me to focus on helping those people with the most troubling of diagnoses, particularly psychosis and schizophrenia. 

I have recently graduated with an Honours degree in Psychology.  I currently work for DRUG-ARM, a government funded organization in Queensland Australia, which deals with drug addiction and experiences cases of drug induced psychosis.  I have voluntarily been spending time with consumers of Integrated Mental Health Services, and the Bayside Initiative Group in Brisbane.  I have been the most diligent of students in the philosophy and psychotherapy of psychotic and other clinical disorders and have completed workshops on Brief and Hypnotic Techniques.

I was pleased to find this web page on “Direct Confrontation”, to read about the insights and experiences of Jack Rosberg, and the experiences of other contributors.  I am pleased to add another very positive experience to this web page and hope that any people who are experiencing psychosis or schizophrenia, are able to access this kind of approach, which offers the most promising of outcomes that I am aware of.  I have included a summary of my experience with a person diagnosed with schizophrenia, and their own experience of me (written without viewing my summary) that was written for this news letter.  I’d like to thank TW for his letter to me, and hope that my summary and his letter inspire similar others to settle for nothing less than a positive future. 

If anyone wishes to correspond with TW, I will let him know.  He may be willing to use the internet connection which his house mate has established. 

James Le Lievre

jameslelievre@hotmail.com

Brisbane, Australia

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The case of TW

In Brisbane, Australia.

TW and L live in a house with another fellow.  Their house is one of half a dozen houses for consumers of mental health.  They are organized by a private person and are referred to by Integrated Mental Health in Queensland. I had seen TW and L once a week for 6 or 8 weeks, two years prior, and have now recommenced my visits.

On the first of these recent visit L made a comment that displayed some uncertainty towards the people within the health care system, which was immediately followed by TW's reassurance to L that I was on their side and not on the other side.  Over the several hours I spent with them they both spoke of their approval and favour towards me.  Early discussion was aimed at finding out if I could improve the level of enjoyment in their life.  I enquired about the things they might do if they could and they agreed that they'd enjoy a drunken party around an outdoor fire but would also like to go fishing at the beach.  They said that they couldn't go by them selves because they both experienced a fear of trains and people (agoraphobia).  Ironically, they both loved trains and wished they could travel on them.

L explained that it was just too confusing.  I asked what happened when he tried, he said he would just lose the plot and freak out.  I asked what he would need if that happened, he said he would need someone to help.  “How could a person help”, I inquired.   “Just by being there to reassure him and let him know that it's OK”, was L’s response.  We spoke about their difficulties for some time and we became familiar with each other once again.  I was always understanding and agreeable.  It could be said that they led the discussion, which they enjoyed very much.  I felt that they were very insistent, and were successful in gaining my consent on all that they wished.  Through out our discussion I told them how much I appreciated being there as it helped me to understand and perhaps help people in their position.  Although I was visiting them for their benefit as much as my own experience, TW did not seem to see how I was of any assistance to them and he said they would be willing to help me any time.  On departure they gave me support and encouragement hoping that things would improve for me (I was not working for an organization). 

On leaving, I didn't feel comfortable about their leading the discussion from start to finish.  I also felt a bit bored and had not even attempted to alter any unusual behaviour. I resolved to turn things around on my next visit and to be more provocative with remarks about their behaviours and their situation, hoping to create awareness, arouse, and motivate them to be more active.  I was also hoping that this approach would make the visit more fun for me as well as it being more helpful for them.

On the second week TW and L were waiting on their chairs outside.  On this occasion I wanted to give them at least as much information as they gave me.  Throughout the visit I repeated that I was interested in finding out as much as possible about schizophrenia, as I wished to one day be able to help people like themselves.  While this was true, I believe that talking about their condition would be a fairly unobtrusive way to find out about their own personal experiences. 

This lead into some lengthy discussion about how many schizophrenics, in their opinion, start as teenagers that reject or leave their parents to spend more time with peers (and perhaps taking some drugs).  This teenager is then rejected by their peers for some characteristic that is not “cool”.  As they try harder and harder to be accepted, they are increasingly ridiculed, and in L’s case, bashed.  As this person becomes more and more anxious, their desperate efforts to be accepted result in stranger and stranger behaviour.  Eventually, they become so confused and disoriented that they try to return to their parents.  When the parents are reluctant to accept the teenager, the teenagers produce the same desperate and strange behaviour that their friends ridiculed.  The parents reject them, and offer little or no help.  At this stage the teenager “freaks out”, breaks down, and are then admitted to hospital.  TW said, "It was like being dropped from 6 feet onto your ass".  L suggested that perhaps it was "10 feet", and we all laughed.  TW was very forward about his beliefs of a biological origin and an un-reversibility of this disorder.  TM said that when things were at their worst, "something clicked", and then he felt that it had all gone too far and that things would never be the same again.

TW and L said it was a bit scary talking about those old memories but were happy to do this for me.  They were unanimous in their approval of me to come to them as often as I liked, and that they would always give me an honest account of their lives.  I said that I would never disclose their identities.  They offered to help me with petrol money for visits, which I declined.

A moment latter I offered to give them an alternative prognosis that stems from an alternative theory of the cause.  I said that it’s just information and they may not be interested.  They agreed to listen.  I gave a behavioural account of the disorder and an optimistic prognosis.  TW became emotionally involved, and became quite uneasy as he insisted that his theory was a “fact” and that no recovery was possible.  The discussion that ensued demonstrated that TW could only state that an idea was either fully correct or fully incorrect.  He could not state that an idea may be possible, or that his position was bases on a theory rather than a fact.  I made some progress in having him accept that his position was a theory and I continually reassured him that I understood him and his position.  I showed that I was happy if I could speak of his explanation as a theory, and the idea that some people recover (an idea that L was able to support).  Even though a little distance came between TW and myself from time to time, I was able to show my desire to understand him which allowed me to summarise and end the subject on good terms.  He was still shaken and said he'd enjoy a beer and offered me one as well, which I declined.  I then proceeded to talk about what I did to relax whenever I felt the need.  I thought that TW’s black and white nature of the world may be worth exploring in my next visit to see if it was contributing to his difficulties in the world.

When I arrived at TW and L's house on my third visit, only TW was there.  He is usually sitting in a chair out the front of his share house whether he is expecting me or not.  He must have heard the sound of my bike arrive as he made his way to one of the chairs.  At first I was a little disappointed that L could not be there, as TW, L and myself together have a good vibe, they both seemed to enjoy my visits, and I believe they felt safe with each other there.  At first TW was a little more reserved than usual and I believe that my being with him alone produced some uneasiness.  We asked how each other had been over the week, without any genuine responding, so I immediately took the opportunity to break this pattern of social politeness and be very genuine.  I spoke of my disappointment about my very poorly organised BBQ over the weekend.  It was not long before he mentioned his extended family and asked if I'd like to see a photo, and I did.  We were soon talking about his gardening when I mentioned that he could be paid for that sort of work.  At his disinterest, I guessed that there may be no reason for him to work and wanted to check by asking what he would do if he had some extra cash.  After his mention of buying a guitar I inquired about his playing and we went to the garage, his bedroom, for a little demonstration.  I enjoyed his playing, especially in comparison to my own attempt.  I told him how much I enjoyed the rhythm of his tune and he explained that it was his own song and that it was the sound of a train.  I felt that he was sad that he could no longer enjoy travelling on trains.

Persisting with the idea of getting TW more active, we returned to the front of the house, and I suggested that with some gardening work he could buy a new guitar in a couple of weeks.  We talked about other types of work though every suggestion was met with ambivalence.  I suggested employment agencies, but he preferred knocking on doors.  I enquired about these doors, he said he could get a job sweeping floors down the road at a factory, but then said the medication didn't allow him to be reliable.  I found out it was worst in the mornings which left him the afternoons.  He then said it would soon become too boring, I said that was a good point and that another 30+ years in these chairs would be much more interesting.  We laughed.  When he said he'd rather study, we spoke about the options but he said he didn't know what to study and didn't feel up to it.  I said that's OK, there's nothing wrong with talking for 10 minutes about something you're not interested in, we laughed again.

After a while he said he was very happy being where he was and that if ever he lost his pension he'd go and find work.  When I mentioned how nice it must be to enjoy his early retirement (now mid 30’s) and that any work might threaten his lifestyle.  He said that this was pretty much what it's all about.  If he could show that he could work, they might make him work, and he may not be able to handle it, in fact he said he really wanted to avoid all that emotional stuff.

This statement was intriguing, as I had never heard any one refer to life outside the house as emotional stuff.  When I asked what he meant, he explained that he didn't like change, he liked things to be the same, and that anything new was uncomfortable, emotional, stuff.

While finding that TW was lost for direction or stuck in a rut may have seemed useful, it was in fact a behaviour of TW's that occurred during the discussion, which was most revealing.  Throughout our discussion I was struck by a repeated expression of ambivalence.  It was not the expression which was unusual, but the times at which he used it.  When I reflected TW's suggestions back, to allow him to expand, instead of expanding, he made a tone which expressed ambivalence.  To me, it seemed as though he was ambivalent about his own suggestions. 

At this point I thought he may be ambivalent about his own ideas because they were new.  If he had had a bad experience with one or two new things, then he may not like anything new because he expected a bad experience with it.  I thought of this because the previous week when I brought three herbal tea bags, one for each of us, he declined the offer to try it and said that he liked his usual tea or coffee, even though he had never tried herbal tea before. 

To check whether TW considered all new things to be scary, I decided to find out if there were any things he had never done that he regarded as fun rather than scary or stressful.  To help clarify this idea I reminded him of his art and asked if he ever thought about things visually.  He was ambivalent again and he asked what I meant.  I said that I often thought in terms of pictures and that If he didn't mind I'd like to try drawing a picture to try and find out if I saw the emotional stuff in the same way that he did.  He fetched a pen and paper, for which I expressed my thanks.  I drew two large circles, one small circle for the “not  emotional” (familiar) stuff, and one large circle for the emotional (unfamiliar) stuff.  In the “not emotional/familiar” circle I placed his house, house mates, and prepared meals, etc.  In the large “emotional/ unfamiliar” circle I placed another two sub circles; one for the “unfamiliar bad” stuff, and one for “unfamiliar good” stuff.  I then asked him what he would put in the “unfamiliar bad” emotional circle and handed the pen and paper to him.  He promptly drew his own two circles within the big “unfamiliar/ emotional” circle, and instead of labelling them as “bad” and “good” or “scary” and “fun”, he labelled them as “achievements so far”, and “impossible”.  In other words, anything that has not been done already was, not potentially scary or fun but, impossible.  When I asked what goes in the “impossible”, he mentioned an item, but when I used reflective listening and asked for him to confirm that this thing was impossible, again I heard his ambivalent sighing, and he would not profess the item to be impossible.  To this I said “so why create a category if nothing belongs in it”, he laughed and I joined in.  We were back where we started, ambivalent responses when I prompted him to expand on a point.

I returned to my diagram and asked what goes in the bad emotional circle.  He said that he knew where I was going with this, but I pointed out that I did not.  I explained that I was just trying to understand him. With out him offering any items for my “unfamiliar/ bad” category, I offered some suggestions such as “work” and “using trains”, to which he gave his unusual sound of ambivalence.  I could not yet understand why he was ambivalent about these straight forward questions and, in addition, he was now developing signs of anxiety.  Hoping that he may now be able to reveal his feelings to me I said, “you sound unsure....is this difficult”.  He said that this was the sort of stuff that they did at the Barret Centre (Mental Institution) twenty years ago, and that he really didn't like it.  I apologised, and said “what exactly is it, you don't like this whole activity”, he agreed, so I tore off the page, screwed it up, and threw it away.  He laughed and so did I.  He said he was sorry, and that he just felt really uncomfortable about questions and answers and all the analytical thinking.  I asked if he minded that I pick up the paper and put questions, answers, and analytical stuff in the bad emotional circle for my own record.  He said it was fine and he was sorry again and added that I had touched on a really sensitive nerve.  I said that I appreciated him telling me so, I didn't want to upset him, and I was sorry if it reminded him of bad times, but that I appreciated him telling me what he didn't like.  He said “I just don't know how to respond, I don't know the correct way, I know there is a right and wrong way to respond and I really like to know the correct way.  When I don't know how to respond I start to panic, and that’s when I go weird and freak people out”.   TW may have been so unfamiliar with someone wanting him to expand on what he had said, through reflective listening, that he thought I was looking for a correct answer, testing him, or being critical, and so his ambivalent sigh and anxiety become understandable. 

It seemed that believing that there was a correct response and not knowing what to do, was expected to result in the loss of contact with whoever he was with.  I asked if that was what happened when he was rejected from his peers, he said it was and that “I guess that's why you always need to know what the cool behaviour is or you get dropped on your ass”.

I asked whether not knowing how to respond is what made all the knew stuff (including new questions) so emotional and uncomfortable, he said “I guess that's it James, I just don't know how to behave”.  He went on to apologise for being so uncomfortable  a moment ago and said “I hope you don't leave here and think to yourself, gee TW is pretty weird, and then not come back”.  I told him “I didn't come here to see correct behaviour, I came here to see TW and L”.  I reached across and we clasped each other's right hand.  He said “that’s really cool James, you’re really good with people James, you've got a really good bedside manner”.  I said, “you can't imagine how much weird stuff goes on out there” and gave a bunch of examples to help him see that there is not necessarily a correct way to behave, and that “uncool” behaviour is common.

On my forth visit, there was only TW again.  TW was pleased to see me.  He immediately said he had bought a box of green tea and that he preferred it to coffee or tea, and felt better for drinking it.  TW also said that he had reduced his alcohol intake from about a dozen beers a week to about half a dozen beers a week.  We shared our past week with each other and simply enjoyed each other's company. 

Towards the end of my visit I mentioned that I'd like to send a summary of our most important interactions to Jack Rosberg for inclusion on his web page because Jack and I believed that our (TM and myself) time together was the sort of interaction that may be good for people in his situation to give them a greater desire to be more active or feel better about the things they're already doing.  This is when TW explained to me how he felt.

TW said that things were starting to change lately and that he didn't know what had lead to the changes.  He said he had been able to buy the tea bags at the shops, as well as other activities, with greater ease.  He said that perhaps it was because of our time together.  It was of particular significance that he was able to talk about things that he has never been able to talk to anyone about.  TW said something like the following. 

“You know James, something happened last week.  It was when we were in the middle of our discussion and you were drawing those pictures.  We got to a point, we shook hands, and then something just clicked.  Since then I haven't been feeling so self-conscious.  It's not about words or something I think about, It's just the way I feel.  I feel different.  I think something has happened.  I've seen shows on TV where a Doctor  can just talk to someone and just turn their lives around, but I never thought it would happen to me.”

Before I left for the day I asked him if he had done something this week that scared him.  I wanted TW to expose himself to new situations and feel comfortable  with whatever behaviour he produced.  He mentioned going to the shops to buy his green tea and some other things and I responded positively (without being condescending).  Then I mentioned that many people believe it's important to do something that scares us every day.  TW agreed and was positive in his reflection of the difficult things that he had done. 

In short, while TW did not want me to have high expectations of him, he felt that something inside him self had been reversed.  He no longer thinks of himself as a lost cause, he believes that progress is possible, and he looks forward to the challenges of life.  TW and I both realise that he has been out of society for a long time and so has some catching up to do in the social skills department, but we both feel that he has turned an important corner.

During my fifth visit TW told me that he had recorded some of his guitar playing and sent the cassette to his cousin.  While I was with him, he spent less time sitting down and came into the kitchen with me (first time) to make tea.  He was more willing to get involved.  While we were talking about transport, TM asked a lot of questions about my motorcycle and accepted an invitation to sit on it and start it up.  It was the first time he had ever done so in his life.  Shortly afterwards he confessed that it wasn’t as scary as he thought it would be.  Next week he has agreed to go shopping with me to find some new cloths (without holes). A life begins.

(I would like to mention that the ideas for future therapy in TW's letter resulted from unrestricted brain storming with TW, L, and myself, which was terrific fun.  As brain storming produces a wide range of responses, I have not included one of TW's suggestions as I do not believe it was appropriate for this web page.)

A Letter for James

Both L and I think that James is a really good bloke and really enjoy his company.  Mostly we like his down to earth attitude and find that he is really easy to talk to. 

I usually have a lot of trouble communicating with other people and can honestly say that I feel a lot better and have really sorted out some issues.

Talking about problem issues has never really worked for me.  But now I realise that it can really help.  I think that half the battle is finding someone that you can connect with.

I must admit though that medication to me is paramount and being open and honest is really the foundation of all we’ve been getting through.  I can honestly say that there has been a positive change in me. It’s hard to put a finger on, but I feel a real sense of natural calm, and can only put it down to the kind of therapy I’m getting from James.

We talk through issues and come to the real solution, finalise the problem, shake hands, and move on. I don’t really know what’s in the news letter James has written, but some of the Ideas we’ve discussed are really great ideas and would really work.

Early positive therapy that is to help pre mental illness, to watch for symptoms and act upon them.  To get positive information out to the community, with back up response teams.  That is prevention rather than cure.  Alternative therapy.  That is to use friends as a support group.  To make the subject feel safe, loved, and secure.  To use exercise, to motivate social skills.  And at all times to just be the best friend you can be.  These are just some of the things we’ve touched on.

I saw somewhere that schizophrenia may have a cure soon.  But it’s the emotional scars that are left behind that will probably always be there, and if you can cure these, simply by talking and being a friend, what a difference that would make.

I’m not saying that I’m cured or don’t have my usual problems.  But I really do feel better and I guess it’s just nice to have someone to talk to.

All I can say to the sufferers of mental illness out there is to find a friend and talk, but try not to hold too much back, try to be open and honest, try to trust a little bit, and know that you’re important just like every one else.  I realise now that you can talk about things till you’re blue in the face, the trick is having someone to talk to that knows exactly what you’re talking about, and knows what you need to know and can tell you.  It’s like a big puzzle that you both played with as children, you both know the puzzle but now you need some help putting it back together.  The trick is, knowing exactly what you’re saying on the same level in a language you can both understand.  James has shown me that you don’t have to be superman and it’s enough to just have [been] helped a little bit, a little bit is still a hell of a lot and any measure of change is great, especially if it’s positive.

Anyway, I’ll keep on battling on and I’ll keep listening and sharing.

Yours faithfully

Mr T.W.

p.s. Brick by brick.

(This letter was written after four 3 hour sessions.)